Ryan and Jamie Richard

Ryan and Jamie Richard wait for Jamie’s turn to to speak as Lita Pepion, of Indian People’s Action, talks about gaps in Indian Health Service care during a news conference Tuesday at RiverStone Health. Speakers talked about wages in Montana and gaps in health care coverage.

Jamie Richard lives in the middle of what’s called a coverage gap.

She makes too little to qualify for subsidies to buy health insurance through the Affordable Care Act and too much to be eligible for Medicaid.

That means when she suffers any kind of medical problem she has to make a choice. Richard has to decide whether to visit a doctor and risk not having enough money for food and rent, or wait and hope the problem goes away.

She’s not the only one, said Dr. Chris Baumert, a physician at RiverStone Health Clinic.

“I see patients like Jamie literally every day I’m working at the clinic,” Baumert said Tuesday during a news conference at Riverstone that focused on the struggle to make a living wage. “It happens probably two or three times a session, which is half a day.”

Richard and Baumert were two of several people who spoke at the gathering tied to the Tuesday release of a report titled “Low Wage Nation,” by the Montana Organizing Project.

The report was done in conjunction with the Alliance for a Just Society, based in Seattle, said Sheena Rice, lead organizer and lobbyist for the Montana Organizing Project. Both MOP and Indian People’s Action are affiliate members of the alliance.

According to the report, 49 percent of job openings in Montana pay less than $14.40 an hour, the living wage for a single adult. And for every job that pays that wage, on average six people are vying for it.

Eighty-two percent of jobs in the state pay less than $25.82 an hour, the living wage for a single adult with two children. For those jobs, there are an average of 16 job seekers.

A living wage is one that provides enough to cover all of the necessary expenses — food, housing, transportation and health care — without public assistance, Rice said. It also allows for families to save enough for emergencies.

Unfortunately, she said, the Montana Legislature showed its lack of commitment to raising the minimum wage by tabling a bill two weeks ago that would have done just that.

“Short of raising the minimum wage and lifting wages to a living wage standard in Montana, it’s absolutely vital that Montana support the vital systems that help our low-wage earners and invest in the higher-wage industries like health care,” Rice said.

That best way to make that happen, she said, is for the Legislature to expand Medicaid coverage. That would help 70,000 Montanans have access to affordable health care, and it would create an estimated 12,000 jobs that pay well in the health care sector.

Republicans in the Montana Legislature say they are not unaware of the difficulties low-income people face in regard to healthcare. But they oppose Gov. Steve Bullock’s proposal to expand Medicaid to provide health insurance for 70,000 low-income Montanans who now lack coverage.

“Republicans know that we are obligated to care for those who cannot care for themselves,” Senate President Pro Tempore Eric Moore, R-Miles City, said Jan. 28 in the GOP response to Bullock’s State of the State message. “But the governor’s plan to expand ‘Obamacare’ to able-bodied, childless adults takes resources away from the most vulnerable in our communities.”

Instead, Moore said, Republicans want to “promote actual health care.” He highlighted bills by Senate Majority Leader Matt Rosendale, R-Glendive, to “restore the doctor-patient relationship to improve outcomes and reduce costs” and by Sen. Cary Smith, R-Billings, to reduce fraud, waste and abuse in the health care system.

One person who would benefit from the Medicaid expansion would be Richard, 25, who is married to Ryan Richard, 30. Both have been diagnosed with different forms of muscular dystrophy, and Jamie Richard, who is able to work, also takes care of her disabled husband.

If she were to go get another job to make enough money for insurance, her husband would lose his SSI benefits, Richard said. And if he lost his SSI, he could risk losing his Medicaid benefits.

“I also applied for Medicaid because I have a form of muscular dystrophy,” she said. “But because I’m physically able to work and I’m not blind, pregnant or elderly, I’ve been denied.”

Lack of medical coverage affects many different populations, including Native Americans, said Lita Pepion, who works with Indian People’s Action.

“Many years ago, the land that America sits on was owned by Native Americans,” Pepion said. “As an exchange for that land, we were promised health care by the federal government.”

Unfortunately, the Indian Health Service is funded at only about 50 percent of the need, she said. In addition, contract care, under which Native people can see specialists off-reservation, is on a life-or-limb basis, Pepion said.

“If you’re not dying or going to lose a limb, you can’t see a physician,” she said.

Medicaid expansion would help people in Indian Country maintain their health, as well as help them focus on health prevention instead of reacting to pain and trauma.

“If you don’t have a job and you can’t get into IHS, you’re pretty much going to die,” she said.

With unemployment as high as 80 percent on some reservations, she said, adding health care jobs that pay well would be an added benefit.

Baumert talked about one man who came in a few weeks ago with belly pain, and Baumert was concerned he had a stomach ulcer. But when the physician suggested a test to diagnose the ailment, the man refused.

“He said, ‘No way, I just finished paying off an MRI from two years ago,’” Baumert said.

The patient was willing to take a chance that the pain would go away on its own “because he might not be able to pay rent next month,” Baumert said.

He talked about another patient who came in with blurry vision likely tied to high blood pressure. Baumert tried to talk the man into going to the hospital emergency room to get the problem treated.

“He had been to the ER before, he had a bill, and he said it was crushingly expensive,” the physician said.

So the man came back daily to the clinic for the next week or two to adjust his blood pressure medication and get the problem under control. By the time that happened, the man had lost a significant portion of his eyesight.

“As a state we’re making them make choices between having a safe place to sleep at night or food on their tables and taking care of their bodies, their hearing, their sight and their ability to walk,” Baumert said.

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General Assignment and Health Care Reporter

General assignment and healthcare reporter at The Billings Gazette.